D.C.’s struggle to end homelessness is getting more complicated

By the numbers: According to the annual count, 3,403 single adults were homeless, and 39% of them were aged 55 and older.

• That over-representation of seniors has been steady for years.

The wrinkle: Unhoused seniors have far more complex health needs than their housed counterparts.

• Unhoused people in their 50s and 60s in three cities examined by researchers at the University of Pennsylvania had health conditions more akin to housed people who were 20 years older.
• Housing providers are now seeing people with cognitive and mobility challenges at ages far younger than expected, says Courtney Pladsen, director of clinical and quality improvement at the National Health Care for the Homeless Council.
• Pladsen cited heart disease, overdose, and late-stage cancer as leading causes of mortality for unhoused people in recent years, signs of an aging population with limited access to care.

Zoom out: D.C. acknowledges that the aging population is straining its homeless services system. “We have not been able to move as fast as desired to create the number of new affordable and supportive housing opportunities needed for the population,” says its second plan to end homelessness released in 2021.

District officials now plan to make a big investment in a housing model that holds promise for seniors. Will it be enough?

What’s keeping seniors unhoused

“I can sell a paper to a pigeon,” says Phillip Black.

His story: Black is a vendor for Street Sense who often sells papers around Eastern Market wearing a Cat in the Hat hat. He’s 61. And he’s been on-and-off homeless since his 40s.

• Black initially found himself homeless after a health crisis that landed him in the hospital for nearly two months. He says his wife left him, taking their money.
• He has struggled with the restrictions in shelters. “You always gotta follow someone else’s rules,” he says. Some housing advocates believe that shelter rules — such as those not allowing couples to room together — have made them difficult for people to stay, dispelling the idea that people are shelter-resistant and arguing that shelters are resistant to people.

Meanwhile, as D.C. has gotten increasingly expensive, it’s been that much harder for Black to find affordable housing.

• He recently had a heart attack. He now needs heart medication and must keep up with regular doctor visits — a new complication in his pursuit of stable housing.

Zoom out: The housing model that many advocates call a gold standard for ending homelessness for citizens such as Black is known as permanent supportive housing, or PSH.

• It’s a voucher program under which many chronically homeless people with a disability can get intensive case management and pick their own apartment.

Most seniors qualify, Department of Human Services director Laura Zeilinger tells Axios.

• Last year, D.C. invested big in the approach, funding more permanent supportive vouchers through a tax hike on wealthier residents.

Yes, but: Authorizing vouchers is one thing; actually housing people is another.

• While roughly 2,600 vouchers were matched by the end of April of this year, 600 people have moved into housing.

Meanwhile, the number of aging, unhoused seniors hasn’t budged in recent years. Both 2020 and 2021 also saw roughly 40% of unhoused people over the age of 55.

• That’s caused some to worry that most versions of PSH may not be enough to support seniors.
• “As this population grows and continues to age,” more intensive services need to be layered on to PSH, the Homelessness Policy Research Institute concluded in a 2019 report. Those cited include 24-hour crisis response, geriatric healthcare, and transportation assistance.

A smarter approach

D.C. does have a promising housing model — tested during the pandemic — that could be expanded and tailored for seniors, specifically.

Context: Since the start of COVID-19, the city has been relocating medically vulnerable unhoused people over the age of 55 into hotels.

• Participants in the program, called PEP-V, receive case management and follow-up from DHS if they require home health aides or have other intensive health needs, plus meals and 24/7 security.
• 735 of those people — most of them seniors — have now moved into their own homes, DHS director Zeilinger tells Axios.
• In normal times those seniors would be in shelters or on the streets while they waited for vouchers, or looked for the best permanent fit.

Why it matters: Programs like this one have immense potential in improving the health of seniors — which in turn can help them remain in stable housing.

• At a similar initiative in Chicago, where 40% of participants were 65 and older, there was better management of hypertension and diabetes among participants, according to a 2021 study.
• Over half moved into housing following their stay.

While D.C. doesn’t have data on health outcomes for its PEP-V pandemic-housing program, officials and advocates like what they’ve seen so far.

What they’re saying: PEP-V was “really helpful in terms of helping people manage their medical issues,” says Catherine Crosland, medical director for homeless outreach services at Unity Healthcare. “The meals on site … people have access to their bathroom, shower … there is a sense of unity.”

The bottom line: PEP-V isn’t a long-term housing solution, but the approach can be built upon to help seniors find permanent homes. And there are providers in the city who are already showing the way.

Zoom in: Finding a home

Andrea Reid knew she couldn’t get a mastectomy while living in a shelter when she was diagnosed with breast cancer in 2012.

Her doctors agreed, worrying that the mother of three would struggle with stress.

• So, after years of bouncing between her mother’s house and shelters, Reid again returned to her mom’s.
• “Emotionally, physically, spiritually, it took a toll on me,” Reid says.

Today, her doctor’s advice may have been different. That’s because Reid, now 59, resides in what’s known as a project-based apartment building — a souped-up type of permanent housing that is great for seniors in need of additional support.

Zoom out: In project-based housing, more than 50% of a building is occupied by PSH voucher holders. That means case managers can more easily and efficiently work with residents.

• The city funds the vouchers, and residents can stay as long as they want.

• There are eight such facilities exclusively for seniors.

How it works: New Endeavors, the non-profit that runs Reid’s building, has two properties specifically for women aged 55 to 75.

• A case manager can help participants get on Medicare. A life skills specialist may help with medication management.
• New Endeavors’ second facility is a dorm-style arrangement, which helps ease the burden of meal prep, and offers activities such as bowling and computer access.

In her nearly three years housed, Reid has received back-to-work training and landed a job at the USPS.

• Although she recently had to resign citing strain on her back and knees, she’s now hoping to get a desk job.
• The program has also helped her set boundaries with family, and work on anger management, all of which are keeping her healthy.

Reid says she is indebted to New Endeavors, which has helped stabilize her life.

• “The whole journey I fought through because I was homeless, I really pushed, because I love [my grandchildren] that much,” she says.

What they’re saying: There’s little turnover in the New Endeavors programs, says Antoinette Norris, project manager at the non-profit.

• And others see the potential. “If we could do a project-based PSH site in all eight wards, I think that would be a really good way to address homelessness among individuals,” Ward 1 council member and housing committee chair Brianne Nadeau tells Axios.

What’s next

The pandemic has taught the city there are ways to bring seniors in. After all, the COVID hotels-to-housing PEP-V program put 735 people — most of them age 55 and up — into permanent homes.

• “We know we need to build more project-based PSH. We’re planning for that, funding it, and continuing to do that,” DHS director Zeilinger tells Axios.

Between the lines: The working 2023 budget would add 646 permanent housing units for individuals — which is what advocates hoped for.

Yes, but: 146 of the new vouchers would go toward project-based housing.

• Meanwhile, PEP-V may end soon. Zeilinger says it isn’t likely to be made permanent, and it’s currently dependent upon federal funding.

The other side: Not all seniors may want to be in a project-based building, Zeilinger says.

• “Some people may want it, but we really operate around the value of respecting people’s choices around where they want to live.”
• Some residents told Street Sense in 2021 that the COVID PEP-V program’s medical check-ins and curfews denied them some autonomy.

Zoom out: Lessons learned from the pandemic have inspired the city to plug the gap in care for seniors in other ways.

Earlier this year, D.C. opened its revamped 801 East shelter for unhoused men, which includes specific beds for seniors and a medical respite program that gives people who don’t need to be hospitalized a space to recover.

• “We've seen [that] being able to really provide an integrated care model with behavioral health and health care and other services on-site focused on helping people get into the kind of housing they need,” Zeilinger says.

The bottom line: The city’s promise to make key investments in permanent supportive housing options is essential in tamping a worsening aging crisis in homelessness — but it’s dependent on actually housing seniors in places that meet their complex needs.

This article was written with the support of a journalism fellowship from The Gerontological Society of America, The Journalists Network on Generations, and the Silver Century Foundation.

Editor's note: This piece has been updated with more current DHS data, stating that around 2,600 people received vouchers by April and 600 have moved into housing. The updated story also reflects that the fiscal 2023 budget would add 646 permanent housing units and 146 would go toward project-based housing.